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Q. Is there a new code
for ventilation assistance and management? I have been using 94656 and 94657.
A. If you reported
94656 or 94657 since January 1, 2007, you should have been denied payment. These
codes were deleted in CPT 2007. Please review your accounts receivable. Check
with insurers on how far back you can resubmit claims processed in error. These codes
have been replaced by the following four codes since January 1, 2007.
Since the code books
are as large as textbooks required in medical school, taking a full semester to
learn, any physician should be able to take off a semester every other year to study
and digest the new codes. When the physician pays his biller a hundred hours or two
at $25 an hour, he may find the reimbursement for the new codes is actually an
administrative maneuver to reduce his income.
The Medical
Association, that represents 25 percent of physicians, produce the CPT codes and
makes them more money than all the dues the doctors pay.
Nirvana: It looks like the answer
to controlling health care costs is a new Current Procedural Terminology (CPT) book
every year. Doctors won't get paid until it's too late to correct or collect.
____________
Insurance
carriers as Consulting (Controlling) Physicians
I received a notice
from BC-BS stating "available claims suggest your patient has diabetes with no
recent history of lipid-lowering therapy. If your patient does not have diabetes,
please disregard this.
"If after
evaluating the overall treatment goals for your patient . . . please consider: Adding
lipid-lowering therapy. Note that lipid-lowering therapy should be accompanied by
laboratory monitoring (e.g. lipid panels, creatine kinase, liver function tests) and
follow-up visits.
"If necessary,
please provide your patient a new prescription."
The insurance company's meddling
in the private practice of medicine is very costly and does not improve the
quality of health care or patient well being. This patient is of advanced age (ninth
decade of life), and the lipids are only mildly abnormal and will not affect lifespan
even without treatment. Furthermore, treatment with statin has certain risks and may
cause myopathy and myoglobinuria, renal failure and death. Avoiding death can
increase health care costs by a thousand fold if renal complication occurs. The
monitoring guidelines mentioned will further increase the cost of statin therapy by
two to fourfold. The inconvenience and hazards of more frequent visits to the office,
laboratory and pharmacy would decrease the quality of this patient's final years of
life.
As is generally the
case, medical treatment guidelines and government and insurance companies
interference, will increase health care costs significantly - in the range of 10 to
1000 times normal. (1000 to 100,000 percent increase). It would be fair to project
that if all the various recommendations were followed, the $2 trillion annual health
care costs could easily be pushed to 4 trillion and quality would not be better.
It would be more cost effective if
Congress rather than doctors and hospitals were held accountable for their actions.
At least doctors have medical expertise to vary treatment based on clinical judgment,
which is totally lacking in congressional or insurance carrier meddling.
To read more HHK
medical vignettes, please go to www.healthcarecom.net/hhk2001.htm.
To read more HMC, go
to www.delmeyer.net/hmc2002.htm.
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